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nocebo and nocebo effect

Research has...shown that the nocebo
effect can reverse the body's response to true medical treatment from
positive to negative. (Root-Bernstein 1998)

A nocebo (Latin for "I will harm") is something that should be
ineffective but which causes symptoms of ill health. A nocebo effect is an
ill effect caused by the suggestion or belief that something
is harmful. The term 'nocebo' became popular in the 1990s. Prior to that,
both pleasant and harmful effects thought to be due to the power of
suggestion were usually referred to as being due to
the placebo effect.

Because of ethical concerns, nocebos are not commonly used in medical
practice or research. Thus, it is not unexpected that the nocebo effect is
not well-established in the scientific literature. However, there are some
anecdotes and some studies that are commonly appealed to in the literature
to support its validity.

More than two-thirds of 34 college students developed headaches when
told that a non-existent electrical current passing through their heads
could produce a headache.

"Japanese researchers tested 57 high school boys for their sensitivity
to allergens. The boys filled out questionnaires about past experiences
with plants, including lacquer trees, which can cause itchy rashes much as
poison oak and poison ivy do. Boys who reported having severe reactions to
the poisonous trees were blindfolded. Researchers brushed one arm with
leaves from a lacquer tree but told the boys they were chestnut tree
leaves. The scientists stroked the other arm with chestnut tree leaves but
said the foliage came from a lacquer tree. Within minutes the arm the boys
believed to have been exposed to the poisonous tree began to react,
turning red and developing a bumpy, itchy rash. In most cases the arm that
had contact with the actual poison did not react." (Gardiner Morse,
"The nocebo effect," Hippocrates, November 1999, Hippocrates.com) [please see reader comments]

In the Framingham
Heart Study, women who believed they are prone to heart disease were
nearly four times as likely to die as women with similar risk factors who
didn't believe.*
(Voelker, Rebecca. "Nocebos Contribute to a Host of Ills." Journal of
the American Medical Association 275 no. 5 (1996): 345-47. ) [Of
course, one might argue that the women in both groups had good intuitions.
The objective risk factors may have been the same, but subjectively the
women knew their bodies better than the objective tests could reveal.]

C. K. Meador claimed that people who believe in voodoo may
actually get sick and die because of their belief ("Hex Death: Voodoo
Magic or Persuasion?" Southern Medical Journal 85, no. 3 (1992):
244-47).

"In one experiment, asthmatic patients breathed in a vapor that
researchers told them was a chemical irritant or allergen. Nearly half of
the patients experienced breathing problems, with a dozen developing
full-blown attacks. They were “treated” with a substance they believed to
be a bronchodilating medicine, and recovered immediately. In actuality,
both the “irritant” and the “medicine” were a nebulized saltwater
solution."*

Double-blind, controlled studies have repeatedly shown that electro-sensitives can't tell the difference between genuine and sham electro-magnetic fields (EMFs).1, 2 For example, a research team in Norway (2007) conducted tests using sixty-five pairs of sham and mobile phone radio frequency (RF) exposures. "The increase in pain or discomfort in RF sessions was 10.1 and in sham sessions 12.6 (P = 0.30). Changes in heart rate or blood pressure were not related to the type of exposure (P: 0.30–0.88). The study gave no evidence that RF fields from mobile phones cause head pain or discomfort or influence physiological variables.

About 20% of patients taking a sugar pill in controlled clinical trials of a drug spontaneously report uncomfortable side effects — an even higher percentage if they are asked.*

Arthur Barsky, a psychiatrist at Boston's Brigham and Women's Hospital,
found in a recent review of the nocebo literature that patient
expectation of adverse effects of treatment or of possible harmful
side-effects of a drug, played a significant role in the outcome of
treatment (Barsky et al. 2002).

Since patients' beliefs and fears may be generated by just about anything
they come in contact with, it may well be that many things that are unattended to by many if not
most physicians, such as the color of the pills they give, the type of
uniform they wear, the words they use to give the patient information, the
kind of room they place a patient in for recovery, etc., may be imbued with
rich meaning for the patient and have profound effects for good or for ill
on their response to treatment.

"The
Nocebo Effect: Do No Harm" by
Morton Kasdan, M.D. et al., Journal of
Southern Orthopaedic Association Summer 1999. "The nocebo effect creates negative health
expectations that are detrimental to the outcome of the patients
recovery. During the 1960's the nocebo effect was first
described as the "voodoo death". In some regions of the world
the "medicine man" used the nocebo effects to cause death by
fright. More recently, this type of effect is described as
psychogenic illness or mass hysteria" Epidemics usually start
by an individual, in the work place an epidemic is commonly
triggered by an odor. If one or more workers become sick,
attributing symptoms to the smell, anxiety spreads throughout
the workplace and fuels the spread of illness. Nocebo means "I
will harm" in contrast to the placebo "I will please". For my
study with pain management the nocebo effect helps me to
understand how a diagnosis can harm or help a patient with their
recovery. In the diagnosis of pain some may say a more general
diagnoses such as chronic pain has a lesser effect on the
patients initial response and a greater effect on the patients
recovery. Where as with a diagnosis of Reflex Sympathetic
Dystrophy, this diagnosis may lead a patient into a negative
frame of mind in the initial and create long lasting symptoms
and recovery time. Both diagnosis are for pain and both lack
objective findings for the pain. We learned at a young age how
to cope with symptoms and feelings, i.e.. children get the flu
they whine for assistance and they get a reaction. We learn to
play the patient role, and the placement of a name upon a
concept, whether real or imaginary, brings it into clinical
existence. The words used in medicine largely influence the
diagnosis they describe. I guess we could say mind over matter
comes into play when dealing with what a diagnosis really is
saying or what we think it is saying.

The contagious thought that could kill you "Today, the nocebo is perhaps most visible in such controversial disorders as “wind turbine syndrome” (sickness and insomnia from wind farms, most common in Canada) and “electro-sensitivity” – an allergic reaction to mobile phone signals and wi-fi. Some sufferers even resort to sleeping in metal cocoons to avoid the constant ringing in their ears. Yet dozens of experiments have shown that people are just as likely to report the same symptoms when they are exposed to a sham transmitter that doesn’t actually emit any electromagnetic waves."